The invention relates to an instrument for application in endoscopic surgical operations.
An instrument, having a shaft, which receives two forceps extending beyond a distal end of the shaft and pivotal toward and away from one another about an axis extending orthogonally to a longitudinal axis of the shaft, is known from the German Patent DE 43 24 254 C1.
In quite a number of cases in endoscopic surgery it is now necessary to xe2x80x9ccontactxe2x80x9d two tissue fragments which are separated from each other, to maintain them in this contracted state, and to unite them then, e.g. by a suturing or by an adhesive operation.
Examples of such operations may be found in surgical operations of torn ligaments in a joint such as the knee joint, or the in-vitro fertilization of the fallopian tubes. Another example is described in the article by D. J. TIBBS et al. xe2x80x9cArterial Replacement with Minimal Interruption of Blood Flowxe2x80x9d, published in The Lancet, 1958, pp. 292 to 294xe2x80x3.
The performance of these operations with conventional instruments requires not only comparatively long time but also a great manual skill of the physician performing the operation because the surgeon must handle several instruments introduced into the human body and co-ordinate their movements.
The instrument known from the German Patent DE 43 24 254 C1, too, is only conditionally suitable for the performance of such operations because the two bendable forceps, which are introduced separately of each other into a shaft including several ducts, do not allow for a coordinated movement in the sense of a selective approach of the two forceps to each other. Moreover, the individual ducts are disposed on the apeces of an equilateral triangle so that the manipulation of the contracted tissue fragment is rendered more complicated by an instrument introduced through the third duct. Moreover, the jaw elements present an inexpedient orientation relative to the pivoting axis so that a xe2x80x9ccontractionxe2x80x9d of sensitive tissue fragments is not possible.
The present invention is based on the problem of providing an instrument for application in endoscopic surgery, which will facilitate the xe2x80x9ccontractionxe2x80x9d of two tissue fragments which are separate from each other, the holding of the tissue fragments in the contracted state and the subsequent manipulation, e.g. the connection by a suturing or adhesive process.
In accordance with the invention both forceps elements are each pivotable as a unit about parallel pivoting axes such that their mutual spacing in the direction of the transverse axis of the instrument may be varied. With these pivoting axes being at least approximately orthogonal on the longitudinal axis of the instrument the adjusting range for the spacing between the forceps elements is substantially greater than the diameter of the instrument which is restricted by the maximum xe2x80x9copening in the bodyxe2x80x9d available.
Each of the forceps elements has a pair of jaws spaced from one another and extending from the distal discharge opening of a continuous duct so that (inter alia) a surgical instrument may be introduced in the duct for co-operation with the jaws of the two forceps elements.
With this inventive configuration the following method can be performed for connecting tissue fragments separated from each other:
The inventive instrument is introduced into the cavity where the tissue fragments to be united are located. The free ends of the tissue fragments, e.g. the fallopian tubes, are seized with the jaw of one respective forceps element of the instrument. Then the forceps jaws of the forceps elements are xe2x80x9capproached to each otherxe2x80x9d in a direction orthogonal on the longitudinal axis of the instrument. With the two forceps elements of the instrument holding the tissue fragments, the free ends of the tissue fragments to be united are moved towards each other, too. As soon as the free ends have reached a position in which the bonding operation can be performed the operating physician performs the uniting operation. During the uniting operation and possibly even thereafter the parts to be united are held with the inventive instrument. The inventive instrument may, of course, be used also in other treatment or processing operations in the human or animal body or in engineering applications.
In accordance with another aspect of the invention, the pivotable part(s) of the jaw of each forceps element is (are) pivotable about an axis which is orthogonal on the pivoting axis of the forceps element. This orientation, which is opposite to the orientation between the forceps jaws and the pivoting axis as it is known from the German Patent DE 43 24 254 C1, allows for the contraction of sensitive tissue fragments, too, because the jaw elements move approximately orthogonally on the direction in which the tissue fragments are moved when the forceps elements are pivoted.
In accordance with still another aspect of the invention a pivoting actuator element is mounted on the proximal end of the instrument for each forceps element, which, when operated, varies the pivoting angle and hence the distance between the forceps elements in the direction of the transverse axis. The variation of the pivoting angle does not take any influence on the mutual relative position of the jaw elements of each forceps element. It is thus possible to connect the free tissue fragments to be united towards each other with high precision and without any damage to the tissue.
According to yet another aspect of the invention, the forceps elements are designed in the form of known forceps which are introduced, in particular, as a unit into a shaft. This configuration facilitates both the manufacture, stock-keeping at the manufacturing plant, and the cleaning of the inventive instrument. It is moreover expedient that the shaft presents the configuration of a known trocar or a laparoscope. This trocar shaft may have an outside diameter of 10 mm to 13 mm, e.g. when fallopian tubes are to be united.
It is moreover preferred, that the actuator elements for the jaw elements of the forceps are handle piecesxe2x80x94such as scissors handles, forceps handles or the likexe2x80x94which are biased into the position in which the respective forceps jaw is closed. This configuration presents the advantage that the physician need not hold the handle pieces in order to hold jaw elements of the two forceps in a closed condition when the tissue fragments are contracted.
The variation of the distance between the two forceps elements may be achieved in the most different ways on principle. It is possible, for instance, to hold at least one forceps elements in a resilient and outwardly bent holder. Then the forceps element is xe2x80x9cpushed insidexe2x80x9d or the point of articulation is displaced by means of a linear guide or a sleeve.
In correspondence with the invention, the forceps jaws are an element on flexible forceps known per se which have a distal end which is bendable in a way equally known per se.
The pivoting or bending movement of the forceps jaws may be achieved in the most different ways:
For instance, transfer elements such as sheathed cables, connecting rods or traction bars may be provided which transmit the movement of the actuator elements to the forceps jaws. It is moreover possible that distally disposed actuators are provided which create the pivoting or bending movement. The actuators may be micro control elements, particularly electrically operated elements, such as micro motors.
It is furthermore possible to use rigid forceps as forceps which have a distal end that can be bent as a unit and which comprise jaw elements which are connected via a rod or the like to a proximally disposed actuator element. In particular forceps may be used such as those described in the prior German Patent Application 196 25 241.5 of Karl Storz GmbH Co., Germany.
It is preferred that an equalizer mechanism is provided which prevents any variation of the relative angular position of the two jaw elements of the jaw when the distal end is bent or pivoted as a unit, respectively, because then the tissue can neither be damaged nor can slide out of the respective jaw element when the distance between the two forceps is varied.
When a rigid forceps element is used it is moreover preferred that the rod has a flexible configuration in the area of the bend in a manner known per se and closes the jaw in response to traction or pressure.
When a xe2x80x9crigid forcepsxe2x80x9d is used it is moreover preferable to provide a control element and specifically a set screw by means of which element the distal end can be bent or pivoted, respectively, in response to operation of the element.
The set screw may be disposed at an angel of 90xc2x0 relative to the longitudinal axis of the instrument or in a concentric position relative to the longitudinal axis of the instrument.
The manipulation of the inventive instrument is furthermore facilities when certain angular positions of the two forceps are indexed or when the set screw presents catching means at certain angular positions.
The most different instruments may be inserted into the additional duct.
It is possible to use a suturing means upon introduction of a catheter.
When distal and proximal fallopian tube stumps are to be united, in particular, upon introduction of a catheter it is expedient that the adhesive means is a catheter which permits the application of a fibrin adhesive.
The forceps jaws of the inventive instrument may be designed, on principle, in any configuration known. It is particularly expedient, however, that each of the forceps jaws are formed by two clamping jaws. These clamping jaws may be provided with teeth so that the respective tissue fragments may be safely seized.
The shape of the clamping jaws may be matched with the tissue fragments to be united so as to achieve a large-area positive locking.
The adaptation to different surgery conditions is facilitated by the provision that the forceps jaws are additionally displaceable in the direction of the longitudinal axis of the instrument relative to the instrument body. The displacement of each forceps jaw may take place independently of the other forceps jaw. Due to the displaceability in the direction of the longitudinal axis it is possible, inter alia, to compensate for the angular offset which is caused as a result of the pivoting movement. If necessary, a forced guidance is also possible for a compensation of the angular offset.